Fighting Fatigue

by Ellen Manzullo, MD, FACP

Fatigue is the most common and
often most distressing symptom
cancer survivors face. Cancer-related
fatigue is different from the fatigue
we all experience in daily living. Cancer-related
fatigue is usually more severe,
lasts longer, and can have a significant
impact on your daily living. Even simple
activities, such as eating, bathing,
and grocery shopping, may be hard to
do when you are fatigued. In addition,
normal rest might not help you feel more
energetic. Some people may experience
cancer-related fatigue even years after
completing cancer treatment.

Cancer-related fatigue can also be
mental, as well as emotional. At times,
fatigue may cause you to have trouble
concentrating and can make performing
daily tasks difficult. A person who is
emotionally fatigued might experience
difficulty in relationships with family
and friends.

Prioritize your most important activities, and plan to do them
during periods of the day when you have the most energy.

Dr. Ellen Manzullo

There are many possible causes for
cancer-related fatigue. It can be caused
by cancer or cancer treatments, such as
chemotherapy, radiation treatment, bone
marrow transplant, and surgery. It can
also be a sign of an undiagnosed medical
condition, or one that is being
inadequately treated. For example, heart
disease, anemia, hypothyroidism, and
sleep disorders, such as sleep apnea, can
all contribute to fatigue. Pain, depression,
and anxiety can also cluster with cancerrelated
fatigue. It’s important to have a
list of your medications since some can
cause fatigue. Your healthcare team can
review the list and determine if any adjustments
need to be made.

There is usually more than one cause
of cancer-related fatigue in an individual.
Although this symptom can be overwhelming,
several strategies can be used
to fight it.

Energy Conservation Measures
If you are experiencing cancer-related
fatigue, there are many things you can
do to conserve your energy. First, prioritize
your most important activities, and
plan to do them during periods of the day
when you have the most energy. Routine
tasks can be scheduled throughout the
week. It’s important to pace yourself and
delegate chores, such as strenuous housework,
shopping, and laundry, to others.
In the workplace, try to arrange your
environment to conserve your energy,
and plan your most strenuous tasks during
times of peak energy.

Good Sleep Hygiene
Some simple
measures can be taken to help you sleep
at night. During the day, try to limit naps.
If you do nap,
try not to sleep
longer than 30
minutes. In the
late afternoon
and evening,
avoid caffeine,
chocolate, and
alcohol. Also,
limit liquid
intake in the
evening. When
you exercise, give yourself at least two
to four hours before bedtime to recover.
Also, try to avoid activities that are
mentally stimulating prior to going to
bed, such as working on the computer
or playing video games. Try to go to
bed and wake up at the same time every
day, including weekends. Spouses
should try to go to bed at the same time
as well. If you cannot fall asleep within
15 minutes, it’s fine to get up, go to
another room, try listening to quiet
music, and then go back to bed when
you feel sleepy.

Exercise and Nutrition
Although it
might seem difficult, it is important to
remain active. Cancer survivors should
try to exercise every day if possible. Before
beginning an exercise regimen, you
should discuss an appropriate program
with a healthcare professional. Some
people may need to be assessed by a
physical therapist. The eventual goal
would be to achieve 30 minutes of
exercise per day. Studies have shown
that people with cancer who exercise
have more energy, are better able to
perform routine activities, and enjoy an
improved sense of well-being.

It is important to eat a well-balanced
diet with the right amount of calories. If
you cannot eat regular-sized meals, eat
small meals more often. Include protein,
such as fish and lean meats, in your diet.
A dietitian can instruct you on the best
sources and amount of protein for you.
You should also remain well hydrated by
drinking eight 8-ounce glasses of nonalcoholic,
non-caffeinated fluids each day.

Restorative Therapy
It is beneficial
to engage in activities that you enjoy and
that help you feel relaxed. Try to set aside
time at least three times a week for an
activity that you enjoy, such as listening
to music, gardening, walking through
a park, bird watching, or visiting with
friends and family. You might also want
to try relaxation exercises and meditation.
These activities can be both mentally
and physically restorative.

Although cancer-related fatigue is
one of the most common and distressing
symptoms for cancer survivors, many
measures can be taken to help manage
this symptom. If fatigue persists and
significantly interferes with your daily
life, promptly discuss this symptom
with your healthcare provider.

♦ ♦ ♦ ♦ ♦

Dr. Ellen Manzullo is a professor of Medicine
at The University of Texas MD Anderson
Cancer Center in Houston, TX. She is the
deputy division head for the division of Internal
Medicine and chief of the section of
General Internal Medicine. Dr. Manzullo
also evaluates and treats cancer survivors
in the fatigue clinic.

This article was published in Coping® with Cancer magazine,
July/August
2012.